In Nigeria, R4S is engaged in three activities: 1) conducting Performance Monitoring for Action surveys with a new self-care module, 2) testing a digital training tools for FP providers, and 3) capturing COVID-19’s impact on FP service delivery and use. These activities are part of the three R4S portfolios below.
Self-Care Portfolio
R4S’ Self-care Portfolio includes activities aimed at deepening understanding of self-care through a people-centered approach. Countries increasingly seek to integrate self-care into FP policies and programs. But there is little evidence available to create an enabling environment for self-care programming, despite the growing appreciation that self-care is a culturally relative concept. R4S has designed and implemented studies to capture attitudes, preferences and intentions regarding FP self-care from women, men and providers.
1. Under the Self-Care Portfolio, R4S collaborated with Johns Hopkins University to add a self-care mini-module to the Performance Monitoring for Action (PMA) surveys in Lagos and Kano, Nigeria and in Kenya with 21 questions on women’s interests and preferences regarding FP information and selected contraceptive methods (oral contraceptive pills (OCPs), emergency contraception (EC), self-administered injectable contraceptives) that women can administer on their own, without necessarily interacting with healthcare providers. The survey was conducted in February – March 2022. Among the key findings, the study revealed that there is high demand for information related to fertility and FP that can be accessed through voice/text and through social media. While the health facility is a preferred source of accessing FP, was also some interest among women in accessing self-administered products through non-traditional channels such as drug shops and pharmacies, and other sources including home delivery.
HIPs Portfolio
Includes activities that assess multiple service delivery practices to inform programmatic decisions for scale-up – either vertically into local or national health systems and policies, or horizontally to new geographies or groups. Knowledge generated can facilitate advocacy efforts for the adoption and sustainability of interventions that are proven to enhance the impact of FP programs and investment of resources to address equitable access to services among traditionally underserved populations or groups.
2. Under the HIPs Portfolio, R4S worked with the Nigeria Federal MOH, and the Society for Family Health (SFH) on a study to produce evidence to guide development, adoption, and future scale-up of a digital training tool to provide an alternative option to the didactic, in-person components of a hormonal intrauterine device (H-IUD) provider training in Nigeria. The training was conducted in September and October 2021. This study found that the hybrid digital training approach to hormonal IUD was highly acceptable, produced high knowledge gains and skill levels, and resulted in potential cost-savings relative to traditional, in-person training alternatives. These results are intended to guide further optimization and use of digital training modules, adaptations to the implementation approach, inclusion of other FP methods and/or targeting additional cadres of providers.
COVID-19 Portfolio
During the first year of the COVID-19 pandemic, R4S designed and implemented studies aimed at capturing the pandemic’s impact on FP service delivery and use, as well as documenting the lessons learned from program adaptations.
3. Under the COVID-19 Portfolio, two programs in Nigeria supporting FP/RH services for women in humanitarian settings were included in a mixed methods study to 1) quantitatively describe the extent to which FP and RH service delivery changed during the pandemic and 2) qualitatively document programmatic adaptations to FP/RH services in response to COVID-19 and identify successes and challenges of those adaptations. Our results show both that lockdowns had significant effect on provision of services and that adaptations allowed the continued provision of essential FP/RH services without significant negative decline. Examples of adaptations included increased access to key FP and RH services by providing them in new venues, at new times and in ways that enhanced patient access and control. Facility level adaptations, such as multi-month dispensing, changes in client flow such as offering appointments and increasing the number of service days, ensured provision of key FP/RH services. In addition, in 2020 R4S began systematically documenting adaptations across eight FP programs in Nigeria, Kenya, Uganda, Zimbabwe and India using a qualitative approach. An interactive site was developed to showcase adaptations and experiences of eight family planning programs in the five countries. Since its launch, the interactive site has received nearly 900 views from at least 37 countries.
